Harvard Public Health Review Winter 2007
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Exposing the Roots of Health Disparities
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David Williams
David T. Williams

Reversing entrenched policies
Williams is frenetically busy, always on the move. Yet, sitting in his box-filled office, he is expansive, his conversation accented with the lilt and softness of St. Lucia, an island nation in the Caribbean where he grew up.

His college studies, in nearby Trinidad, were in theology, not as a road to the ministry but because of his view of the church as "a foundation for meaningful engagement and service to community." After college, Williams came to the United States, braving the bitter Michigan winters, to study at Andrews University, the flagship educational institution of the Seventh-day Adventist Church, which promotes preventive health practices such as exercise, vegetarianism, and abstinence from smoking and alcohol. Williams earned an MPH from the Adventist Loma Linda University in California, his field work bringing him back to Michigan as a health educator at an Adventist facility in Battle Creek.

There Williams worked in fitness, stress management, and heart-disease risk-reduction programs, where he says he was impressed by "the extent to which health practices and behaviors of individuals were shaped by larger social forces. The nature of the family environment was a strong predictor of the long-term success of a stop-smoking program, for example." This insight led to a PhD in sociology from the University of Michigan where, after a six-year stint at Yale, he returned in 1992 as professor of sociology and senior research scientist at the Institute for Social Research.

Along the way, personal experience fed into Williams' views of the corrosive effects of racist attitudes upon psychological health and well being. Not long after emigrating to the United States, for example, Williams and four other black university students were pulled over by Indiana police at about 1 a.m. on their way back to Andrews University from a weekend trip. The driver was allegedly speeding, but when the officer insisted on seeing the licenses of everyone in the car, the young men felt the sting of racism. "It made us all angry--we were nearly home, we were tired, we felt we shouldn't have to do this," remembers Williams.

A more menacing act shook him and his wife in the predominantly white neighborhood of Battle Creek, Michigan, where they were renting an apartment. "As I was going to sleep there was an explosion, and a flash of light," Williams recounts. "Someone had fired shots in the air, and on the lawn of a black family who had just moved in next door, a cross was burning." Although the police sent a hate crimes unit to investigate, "there was nothing reported in the local media." That seeming indifference rankles Williams to this day.

If entrenched social policies have contributed to the insidious health disadvantages that persist among today's minorities, it should be possible, if daunting, to reverse these, Williams believes. As part of a group that is collaborating with the Robert Wood Johnson Foundation, he is working to establish a national commission that will "look systematically at disparities in race, health, and socioeconomic status, and see what policies can be used to improve health."

"It's primarily about improving the circumstances in which people live and work," Williams says. That means job training and initiatives that improve their ability to take advantage of the opportunities that society offers." If there are no easy answers, Williams is nevertheless generating new information he hopes will help societies narrow health and economic divides along racial lines.

"What's phenomenal about David," says Lisa Berkman, who chairs Williams' department and helped lure him to HSPH, "is that he takes data that have long been in the public domain, such as decades of life expectancy data, and uses them to point out underlying causes of racial disparities in health that lay hidden or silent. He's making the roots of disparities transparent."

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Richard Saltus has been a reporter for the Associated Press, the San Francisco Examiner, and the Boston Globe. He writes about science, medicine, and public health.

Photograph: Kent Dayton/HSPH


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David T. Williams

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